These days, sugar is pretty close to everywhere in the American diet. You probably know that too much sugar is probably not great for your health.

Now, a new initiative from UC San Francisco is spelling out the health dangers in clear terms. The project is called “sugar science,” and science there is.

A team of researchers distilled 8,000 studies and research papers, and found strong evidence showing overconsumption of added sugar overloads vital organs and contributes to three major chronic illnesses: heart disease, Type 2 diabetes and liver disease.

While there are no federal guidelines recommending a limit on sugar consumption, the American Heart Association (AHA) recommends cutting our consumption way down. Right now, the average American consumes the equivalent of 19.5 teaspoons a day in added sugars. The AHA says men should cut that down to no more than 9 teaspoons and women should consume less than 6 teaspoons.

UCSF Professor Laura Schmidt is lead investigator on the project. “Right now, the reality is that our consumption of sugar is out of whack, and until we bring things back into balance, we need to focus on helping people understand what the consequences are to having the average American … consume too much added sugar.”

As part of its outreach, Schmidt’s team has created a user-friendly website and is partnering with health departments across the country to spread the word. The website includes downloadable resources, including television commercials, that public health officials can localize for their own cities.

“And that’s what sugar science is all about,” Schmidt says. “It’s about translating the information that’s locked up in the medical journals and sharing it with the public in ways that are understandable.”

Health departments from San Francisco to New York City have already agreed to participate in outreach. In a statement, the New York Department of Health called Sugar Science a “wonderful resource” and said it was “something that can be used by researchers, the public health community and those who just want thorough information.”

Schmidt is quick to point to the food environment as a driver in the increase of obesity that America has seen in the last generation. “It’s not like Americans suddenly lost their willpower,” she says. “The only major change in the diet that explains the obesity epidemic is this steep rise in added sugar consumption that started in the 1980s.”

That sugar isn’t just making us fat, she says, “it’s making us sick.”

Schmidt insists the team, which includes researchers from UC Davis and Emory University, is not “anti-sugar.” Instead, it’s really about knowing how much sugar is too much.

But knowing how much sugar you’re eating can be challenging. Some key facts on the Sugar Science website are these:

Added sugar is hiding in 74 percent of packaged foods. (Proposed changes to the nutrition label would change this by including a separate line for added sugars.)

A common type of sugar can damage your liver — just like too much alcohol.

One 12-ounce can of soda a day can increase your risk of dying of heart disease by one-third.

The site also includes tips on concrete steps that people can take to cut down on sugar. The most straightforward way to cut down on sugar is to stop drinking sugar-sweetened drinks, like sodas, sports drinks and energy drinks, the researchers say. More than one-third of added sugar in the diet comes from sugary drinks. They also recommend reading nutrition labels. While there are 61 different names for sugar on ingredients labels, the UCSF team says that “if the chemical name has an ‘ose’ at the end—as in dextrose, fructose, lactose —- it’s likely to be added sugar.”

Seeing Diabetes as the AIDS Crisis of This Generation

Dean Schillinger is also part of the Sugar Science team. He’s a primary care doctor at San Francisco General Hospital. He first came to San Francisco in 1990 at the peak of the AIDS epidemic. “At that point, one out of every two patients we admitted was a young man dying of AIDS,” he says. At that time, there were no treatments, little any doctor could do.

Today, he says, there are good treatments, and it’s rare to admit someone to the hospital dying of AIDS.

Instead, Schillinger says, that same ward, Ward 5A, where young men died of AIDS is now filled with diabetes patients.

“I feel like we are with diabetes where we were in 1990 with the AIDS epidemic,” Schillinger said. “The ward is overwhelmed with diabetes –- they’re getting their limbs amputated, they’re on dialysis. And these are young people. They are suffering the ravages of diabetes in the prime of their life.”

But unlike AIDS, where activists pushed hard for action from researchers and governments, there’s little activist response for diabetes “because it affects low-income communities disproportionately,” Schillinger said. “We’re at the point where we need a public health response to it.”

The timing of the SugarScience launch is not a coincidence. The UC researchers waited until after the election last week voters in Berkeley and San Francisco were considering soda tax measures. Measure D in Berkeley passed with 75 percent of the vote. Schmidt says that since the university is a public institution, it could not be seen as trying to sway votes with the announcement of the new initiative.

Now comes a new study, published in JAMA Internal Medicine, which finds that Americans who consumed the most sugar — about a quarter of their daily calories — were twice as likely to die from heart disease as those who limited their sugar intake to 7 percent of their total calories.

To translate that into a 2,000-calorie a day diet, the big sugar eaters were consuming 500 calories a day from sugar — that’s 31 teaspoons. Those who tamed their sweet tooth, by contrast, were taking in about 160 calories a day from sugar — or about 10 teaspoons per day.

Unfortunately, most Americans have a sugar habit that is pushing toward the danger zone.

“The average American is consuming 22 teaspoons a day. That’s about three times what’s recommended,” says Laura Schmidt of the U.C. San Francisco School of Medicine.

Now, we should point out, we’re not talking fruit here. Researchers did not include the sugar naturally occurring in fruit or milk. Instead, the study focused specifically on the risks of added sugar — the refined sugars and corn syrups added to foods such as baked goods and sugary sodas.

So, how much added sugar is OK?

For starters, the American Heart Association advises that women consume no more than 6 teaspoons of sugar daily. This is about 100 calories. And men, no more than 9 teaspoons, or about 150 calories from sugar.

The World Health Organization says people should get no more than 10 percent of their daily calories from sugar.

And the last time the federal government weighed in on sugar was in the 2010 Dietary Guidelines, which make only a broad recommendation to reduce consumption of added sugar.

So how best to reduce sugar?

Some steps are fairly obvious. For example, eliminating one 12-ounce can of sugar-sweetened soda can cut about 9 teaspoons of sugar.

But other common sources of added sugar can take you by surprise. For example, this morning I ate a small, 4-ounce cup of low-fat organic peach yogurt. I chalked it up as a very healthy breakfast, but when I looked at the nutrition label, it had 17 grams of sugar.

“You just shot most of your wad” for the day, Schmidt points out.

So, yeah, swap those sweetened yogurts for plain yogurt. A typical 6-ounce serving of vanilla yogurt has about 6 teaspoons of sugar — which is about as much as a regular size Snickers bar.

Bottom line: Read the labels. Most nutrition labels list sugar in grams. Four grams of sugar is equivalent to about one teaspoon.

And, don’t get forgot to count sugar if you’re eating out. There can be lots of sugar added to breakfast foods.

For instance, stopping at Starbucks to pick up a blueberry muffin with your latte? That muffin, according to the Starbucks website, contains 29 grams of sugar, or roughly 7 teaspoons.

And an Apple Crumb Donut at Dunkin Donuts will set you back 49 grams of sugar — that’s more than a day’s worth of added sugar.

There’s a lot of variability in baked goods. For instance, another option at Dunkin Donuts, the Cocoa Glazed Donut, has much less sugar, 13 grams.

]]>http://blogs.kqed.org/stateofhealth/2014/02/04/sugar-is-a-risk-for-heart-disease-too/feed/1Screen Shot 2014-02-04 at 2.13.52 PMA 12-ounce can of Coke has 9 teaspoons of sugar. (Kansir/Flickr)Study: Sugar — Independent of Obesity — Causes Diabeteshttp://blogs.kqed.org/stateofhealth/2013/02/28/study-its-the-sugar-not-obesity-that-causes-diabetes/
http://blogs.kqed.org/stateofhealth/2013/02/28/study-its-the-sugar-not-obesity-that-causes-diabetes/#commentsThu, 28 Feb 2013 19:49:37 +0000http://blogs.kqed.org/stateofhealth/?p=10834For years, doctors have debated sugar’s role in causing diabetes. The prevailing medical opinion has been that eating more sugar means eating more calories, and it’s the resulting weight gain that leads to diabetes. But a major new study shows a direct link between sugar and diabetes — a link that’s independent of a person’s weight.

KQED’s Stephanie Martin interviewed one of the study’s authors, Dr. Robert Lustig from UCSF. Lustig is an expert on childhood obesity and has been vocal about the health hazards of sugar for years. His video “Sugar: The Bitter Truth” has more than three million views on YouTube.

“This is the same level of proof that was available to us when we implicated cigarettes as the cause of lung cancer back in the 1960′s.”

Lustig told Martin that the study was very carefully done — researchers looked at sugar consumption in 175 countries over a decade and controlled for just about everything including obesity, poverty, and physical activity. They found that the more sugar in the food supply, the higher the rates of diabetes in that country, no matter what the obesity rates were.

In the study, sugar was 11 times stronger than total calories in explaining diabetes rates around the world. “Those countries where sugar went up showed increases in [diabetes] rates. Those countries where sugar availability went down, showed decreases in rate.”

Lustig said their findings point to proof of causation that should be accepted by doctors. “This is the same level of proof that was available to us when we implicated cigarettes as the cause of lung cancer back in the 1960’s,” he told Martin. He believes the findings are sufficiently strong to lead to policy interventions around sugar.

Lustig has long suspected sugar as a major driver of diabetes. He pointed out that diabetes afflicts people across the weight spectrum.

“Twenty percent of obese people have completely normal metabolic signatures,” Lustig told Martin. “Conversely, up to 40 percent of normal weight people have the exact same metabolic problems that the obese do; they are just not obese. The obesity is a marker for the metabolic problems which we call metabolic syndrome, rather than a cause.” He cautioned that people who are normal weight, but eat a lot of sugar, could be sick and not know it.

The study was not designed to address whether the type of sugar mattered — for example, table sugar versus high fructose corn syrup. Lustig said that in the study researchers looked at all sugars collectively, not individually.

Marion Nestle, professor of nutrition, food studies and public health at New York University was not affiliated with the study, but in a release she praised the research saying it was the first paper she knew of to link sugar consumption to diabetes. She said the study adds to a body of research that is sufficient to “advise people to keep their sugar a lot lower than it normally is.”

In his medical practice, Lustig says he sees adolescents with Type 2 diabetes. He asserts that one-fourth of U.S. adolescents consume at least 840 calories a day in sugar, more than 40 percent of a daily diet of 2,000 calories. “The question is,” he asked rhetorically, “what does that do to you? What does that do to your liver? What does that do to your pancreas?”

Dr. Robert Lustig is perhaps the most outspoken anti-sugar critic out there. His 90 minute video, Sugar: The Bitter Truth, has netted 3.2 million views on YouTube; his latest book Fat Chance, which, among other things, links sugar to obesity and chronic disease, is currently #68 on Amazon’s Top 100 bestselling books.

On Monday, Lustig was a guest on KQED’s Forum and even though he was fighting a bad cold, he was his usual passionate self on many things related to the American diet, especially sugar. Lustig believes sugar is such a dietary menace that it should be regulated, much the same way alcohol is regulated.

He rattled off a lot of numbers during his discussion with Forum host Michael Krasny.

Nearly one-half cup of sugar per day

“Our current sugar consumption is 22 teaspoons per day, on average … for all of America,” Lustig told Forum‘s audience. For reference, that’s nearly one-half cup. “The American Heart Association put out a scientific statement in 2009 recommending that we reduce that to six teaspoons a day for women and nine teaspoons a day for men.”

To follow Lustig’s recommendations, that means we would need to cut our sugar intake by two-thirds to three-fourths. How did we get here? Our sugar consumption has been climbing for two decades as cited by this 2010 analysis by the UC Berkeley Center on Weight and Health:

“All lines of evidence consistently support the conclusion that the consumption of sweetened beverages has contributed to the obesity epidemic. It is estimated that sweetened beverages account for at least one-fifth of the weight gained between 1977 and 2007 in the US population. Actions that are successful in reducing sweetened beverage consumption are likely to have a measurable impact on obesity.

Sugar-sweetened beverages are a major contributor to overall sugar consumption, but they are not the only one, Lustig says, pointing out that one-sixth of our sugar consumption comes from sweet things like desserts and ice cream. “But … one-half of our sugar consumption is coming in foods that we didn’t even know had it — like tomato sauce, like salad dressing, like barbeque sauce.” And the list goes on.

Lustig had plenty more to say — and addressed criticisms of his science. Listen for yourself here:

Today FDA Commissioner Margaret Hamburg was a guest on KQED’s Forum. Host Michael Krasny asked her if sugar should be removed from the FDA’s “GRAS” category–that’s for Generally Recognized as Safe. Not surprisingly, the Commissioner did not announce imminent action. She said she did have a chance to “look quickly at the initial report” and that “we’ll look very seriously at any new data that’s presented.”

In other words, nothing will be happening soon, just as researcher Robert Lustig expected when I talked to him last week. The commentary was an “opening salvo,” he said. “Nothing in public health changes overnight. It’s not possible to.”

Here’s the Commissioner’s complete response to Krasny’s question:

Sugar is one important area of nutrition where there’s enormous interest in deepening our understanding of the health risks and benefits. It’s an area where consumers want to know more about what’s in the food that they’re eating and where the FDA has a critical role to play in terms of both supporting and building on important new research insights and through our responsibilities for providing accurate information about the content of processed foods.

As the Commissioner continued speaking, she seemed in this next section to be choosing her words very carefully:

So, it’s an important area that sugar, along with other critical nutritional issues, such as sodium and saturated fats and overall calories all require strengthening our understanding of the science and really understanding individual and public health issues and linking that to what we do at the FDA.

Then she picked up steam again here:

But I have had a chance to look quickly at this initial report, I understand the request that’s being made. We’ll look very seriously at any new data that’s presented. In the meantime, consumers should be aware that nutritional information is provided on the back of processed food packages that enables them to look at the relative contribution of different types of sugars in the foods that they’re eating along with other nutritional components and it’s an opportunity to make more informed choices about the food they eat and the food they serve their families.

A spoonful of sugar may have helped the medicine go down when Julie Andrews sang the song, but fast forward to the 21st century and sugar isn’t looking so sweet. Today in a provocative commentary in the journal Nature, researchers argue that sugar is so toxic to our bodies, it should be regulated in the same way alcohol and tobacco are.

The three writers, all from UC San Francisco, say that every country that has adopted the Western diet, with its hallmark of highly-processed food, has seen rising rates of obesity and the diseases that go with it, such as heart disease and diabetes. But, in a turn, they argue against blaming obesity itself. “Obesity is not the cause,” they write, “rather, it is a marker for metabolic dysfunction, which is even more prevalent.” Metabolic syndrome leads to diabetes, high blood pressure, heart disease, fatty liver disease and even cancer, they say.

And the culprit, they insist, is sugar, particularly its fructose component. “Fructose, which is the sweet part of sugar,” said co-author Robert Lustig in an interview, “is toxic beyond its caloric equivalent.” People often refer to sugar as “empty calories,” but they are far from that, the writers say. “A growing body of scientific evidence shows that fructose can trigger processes that lead to liver toxicity and a host of other chronic diseases. A little is not a problem, but a lot kills slowly.”

At this point I was getting a sinking feeling. Maybe it’s the way smokers felt when the bad news started coming out about tobacco in the late 50s and early 60s.

Sugar consumption has tripled worldwide in the last 50 years, the writers assert, and they say to combat the myriad health problems we face today, regulation is necessary. Sugar meets four criteria that merit government action. “The first in unavoidability,” Lustig said, “it’s everywhere. The second is toxicity beyond its calories. The third is potential for abuse because it activates the same areas of the brain as alcohol and tobacco creating a cycle of consumption and disease, and the fourth is negative impact on society.” The negative impact on society is largely seen through high health care costs because of the many diseases associated with high sugar consumption.

The authors suggest a combination of taxes on processed foods that contain sugar, and limiting access to children through tighter controls on vending machines in schools, for example. They also recommend promoting healthier foods in government programs for the poor, including the Women, Infants and Children program and Supplemental Nutrition Assistance Program (formerly called Food Stamps).

Not surprisingly, the Sugar Association doesn’t buy much of this. In a statement on their website, the Association says:

… the assertion that a food is less healthy just because it contains sugar is misleading and not science based. Numerous studies have confirmed that sugar makes many healthful foods palatable, which helps contribute to intakes of key vitamins and minerals necessary to maintain good health.

But Lustig views today’s commentary as the “opening salvo” in a long public health discussion. “I don’t expect anything to change anytime soon,” he said. “Nothing in public health changes overnight. It’s not possible to.”

And judging from some of the comments on a CNN story about the issue today, Lustig is right. Here are just two examples:

“unbelievable nannyism. But I forgot that this is America, the land of the hopelessly dependent and depressingly irresponsible,”

“This article should be regulated as total garbage.”

But as the writers close their commentary in Nature, they point to other public health issues: the bans on smoking in public places; the promotion of the designated driver; and airbags in cars. “These simple measures–which have all been on the battleground of American politics–are now taken for granted as essential tools for our public health and wellbeing,” Lustig said. “It’s time to turn our attention to sugar.”